Bevin K. Shagoury, Communications & Education Director Academic Detailing For the Opioid Crisis: An Overview January 26, 2018 Bevin K. Shagoury, Communications & Education Director National Resource Center for Academic Detailing Division of Pharmacoepidemiology and Pharmacoeconomics [DoPE] Brigham and Women’s Hospital | Harvard Medical School Bevin

The Goal of Academic Detailing Closing the gap between: Best Available Evidence Actual Clinical Practice Bevin 2

Clinicians Want the Best Outcomes Bevin

Primary Care Burnout: Stats Automated interventions hitting point of diminishing returns Pay-for-Performance contributing to burnout 10% of physicians identified their burnout as “so severe I’m thinking of leaving medicine.” MedScape, Mayo Clinic, VITAL Worklife2015

Academic Detailing can offer: Clinicians Value: Academic Detailing can offer: Continuous engagement & sense of purpose Ability to reinvigorate primary care Continued learning & tools around complex topics (e.g. opioid safety) Time Support Mastery Bevin

Bringing Evidence-based Medicine to Clinicians Clinicians need high quality data that is: Relevant to clinical problems In a practical, easy-to-use format Customized to their clinical setting Focused on real-world decisions Academic detailing can meet these needs.

Trusted Clinical Information Academic Detailing Industry Great Communicators Academia Trusted Clinical Information Bevin 7 7

Academic Detailing Evidence Base Evaluated extensively in multiple settings Large evidence base confirms efficacy: A large systematic review in 2007 combined 69 studies and confirmed efficacy of AD New NHLBI systematic review in Jan. 2017 showed AD visits effective in improving both process of care and clinical outcomes *O’Brien MA, Rogers S, et al. Cochrane, Database of Systematic Reviews 2007 **Chan W, Pearson T, et al. AHA Circulation Journal, 2017 Bevin 8

AD is Adaptable for Diverse Clinical Needs Long term care Opioid Stewardship & Safety Cancer Screening Pediatric Screening HIV/STD Screening + Treatment Chronic Disease Management Smoking Cessation Bevin Mention learning from Australia, as well as the VA’s national program, here. Talk about opportunities for collaboration among NaRCAD and other US programs (like VA), CEP and CADC, and other international groups like Australia. 9

The Method of Academic Detailing It’s educational outreach. 1:1 visits in the frontline clinician’s own office A supportive service for better patient care Information is provided interactively to: Understand the clinician’s knowledge, attitudes, behavior Keep the practitioner engaged while continuing to assess needs The visit ends with specific practice-change recommendations. Over time, the relationship is strengthened, based on trust and usefulness.

The Structure of a 1:1 Visit Bevin

Examples of Messages for Clinicians to Improve Outcomes for Opioid Use Disorder (OUD) Where there are high rates of opioid prescribing: “You can offer evidence-based treatments, such as medication-assisted treatment (MAT) and behavioral therapy, for your patients with OUD.” “I can help you with the waiver application and management process to prescribe or dispense buprenorphine for opioid dependency treatment.” Where there are high rates of opioid overdose: “You can co-prescribe naloxone to your patients at high risk of overdose, and I have educational materials for your patients’ friends and families about how to administer it.” “Avoiding concurrent prescribing of opioids and benzodiazepines lowers the risk of opioid overdose.” Bevin

Elements of a Successful Program Identifying gaps in care Defining intervention goals Recruiting & training detailers Detailers visit providers 1:1 Evaluation & assessment Building capacity & sustainability Bevin

Ongoing Technical Support Bevin

Connect with us narcad.org Questions? Connect with us narcad.org Bevin